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NPI Code Detail

MEDICARE: DAVID E MATTHEWS LCSW

MEDICARE: DAVID E MATTHEWS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1205896784
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID E MATTHEWS LCSW
Provider Business Mailing Address
First Line : 212 KANE DR
Second Line :
City : HERRIN
State : IL
Zip : 62948-2535
Country : US
Telephone Number : 618-988-8273
Fax Number :
Provider Business Practice Location Address
First Line : 109 LOU ANN DR
Second Line :
City : HERRIN
State : IL
Zip : 62948-3733
Country : US
Telephone Number : 618-988-1330
Fax Number : 618-988-8321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2006
Last Update Date : 07/08/2007

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Directions to “ DAVID E MATTHEWS LCSW” Practice Location

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